Abstract The evidence-based psychological therapy for obsessive compulsive disorder (OCD) is cognitive behavioural therapy (CBT) delivered by mental health professionals who are trained and regulated by a professional standards authority. In recent years, people with OCD have reported consulting unqualified and unregulated coaches. We aimed to explore the experience of people who sought unregulated coaching for OCD. Using semi-structured interviews, we explored the lived experiences of 13 people with OCD who have undertaken sessions with an unqualified individual (referred to as a ‘coach’). Thematic analysis was conducted. There were four coaches rated negatively and one rated positively. Four over-arching themes were identified in the coaches who were rated negatively: (1) Appealing content, (2) Vulnerability, (3) Cult-like experience, and (4) Complex peer relationships. There were some positive experiences of coaching described, such as positive peer support from others receiving coaching in group chats. Many of the experiences documented by people who received OCD coaching were negative. It was highlighted that unqualified coaches may increase vulnerability of people seeking OCD treatment, due to unprofessional conduct. We suggest that this unprofessional conduct may be investigated by a regulator. We suggest that people seeking OCD treatment seek help from qualified professionals and that clinicians are aware of the potential negative effects such coaches can have on people. Key learning aims (1) To understand the potential risks, vulnerabilities and potential positive aspects associated with unregulated coaching for individuals seeking OCD treatment. (2) To discuss our findings to promote informed decision-making by encouraging individuals with OCD to seek treatment from regulated and qualified mental health professionals. (3) Increase clinician awareness of the potential harms associated with unqualified coaching and equip them to guide patients towards evidence-based treatment options.

Abstract This study explored junior mental health workers’ experiences of conducting assessments involving traumatic events. Semi-structured interviews with 11 junior mental health workers from a UK primary care mental health service were analysed using reflexive thematic analysis. Participants discussed themes of ambiguity in distinguishing trauma and PTSD, high levels of pressure, management of personal distress, appropriate training, and personal support in-service. Findings corroborate previous research regarding challenges experienced by junior mental health workers and offer novel insight into the challenges faced when assessing service-users’ experiences of traumatic events. Recommendations regarding future training, service design and emotional outlets for junior mental health workers are offered. Key learning aims (1) Following reading this paper, readers will better understand the diagnostic and practice-based complexities involved in assessing traumatic events as a Psychological Wellbeing Practitioner (PWP) in an NHS Talking Therapies service. (2) Readers will also be aware of the emotional challenges PWPs in this service have reported experiencing as a result of assessing service users that report having experienced traumatic events. (3) The reader will also learn about PWPs’ perspectives on what could improve this NHS Talking Therapies service’s processes involved in assessing traumatic events and reflect on whether this might be generalisable across other, similar services.

Abstract Video-recordings are considered crucial for effective supervision, but empirical evidence is limited. We thus conducted a naturalistic study to assess supervisees’ evaluations of a structured video-supervision technique (‘Give Me 3’ [GM3]) compared with video-supervision as usual (VSAU) and supervision based on self-report (SAU). Twenty-four participants in postgraduate training in cognitive behavioural therapy conducted each supervision method and provided quantitative ratings of supervision satisfaction. A subsample of nine trainees participated in semi-structured qualitative interviews. Repeated-measure ANOVAs revealed no difference in post-session ratings of supervisees’ satisfaction with supervision. Retrospective comparisons of the three supervision methods resulted in significant differences in perceived effort and comfort but not in usefulness. The qualitative interviews suggested that the supervisees generally appreciated the benefits of video-supported supervision, while evaluations of GM3 and VSAU were mixed. VSAU and GM3 both appeared to have distinct advantages which might enrich supervision if aligned with the therapeutic context and supervisees’ goals. Key learning aims (1) How does trainees’ supervision satisfaction differ between supervision with or without the review of video-recorded therapy sessions? (2) Is structured video-supervision perceived by trainee supervisees as being more satisfactory than unstructured video-supervision? (3) How do supervisees perceive the differences between structured versus unstructured (video)supervision? When is each method deemed most useful?

Abstract Delphi studies allow for the generaztion of a consensus among experts. This has historically been professional experts in their field. This study aimed to obtain a consensus regarding the most important components of cognitive behavioural therapy (CBT) for depression not only for professional experts (therapists) but also for adult experts by experience. Perceptions of importance between therapists and experts by experience differed in multiple areas including content components such as behavioural activation and experiments, psychoeducation, and homework, which the latter did not agree were important. Experts by experience found several components relating to delivery process important which therapists did not, such as delivery method and session length. The strongest agreement from both groups involved the importance of positive therapist factors such as being non-judgemental, knowledgeable, understanding, and trustworthy. Both groups were in agreement on the importance of cognitive restructuring. Neither experts by experience nor therapists met consensus agreement on the inclusion of mindfulness as part of a wider CBT intervention for depression, being rated among the lowest components for both groups. Findings highlight several aspects of CBT content and delivery which may benefit from review in order to increase acceptability for recipients. Key learning aims (1) To identify what recipients and deliverers feel are the most important parts of a CBT intervention for depression. (2) To compare these responses, and consider reasons why these similarities and differences may exist. (3) To discuss ways in which these differences could impact acceptability and perceived efficacy of cognitive behavioural therapy. (4) To reflect on ways gained knowledge could be used to consider ways to improve the delivery of cognitive behavioural therapy.

Abstract The Senior Wellbeing Practitioner (SWP) postgraduate certificate is a new low-intensity psychological training intended to expand the Children and Young People’s mental health workforce. It builds on the skillset of qualified Child Wellbeing Practitioners (CWPs) and Educational Mental Health Practitioners (EMHPs), by providing training to work with a broader range of presentations including neurodivergence. The SWP Skills and Competency Framework (SWP-SCF) is a new tool developed in response to the need to operationalise and assess the skills necessary to work with the range of presentations SWPs are required to treat, whilst retaining fidelity to the low-intensity intervention approach. As training providers we have used the SWP-SCF with our first cohorts of SWPs as an aid for skill development and reflective practice, as well as for assessment of clinical competency within assignments. Students and tutors have reported good face validity and utility, and further assessment of the validity of this framework appears warranted. Key learning aims (1) To understand the role of the SWP and how this fits into the wider child and adolescent mental health workforce. (2) To outline the key skills and competencies necessary for SWPs to deliver effective interventions at the low-intensity level. (3) To present how the SWP Skills and Competency Framework was developed and how this can be used as a tool within training and supervision.

Abstract The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis (n=115), myalgic encephalomyelitis/chronic fatigue syndrome (n=84) and chronic pain (n=116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations. Key learning aims (1) To gain insights into the presentation of health anxiety in medical conditions. (2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings. (3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.

Abstract Existing research indicates that clients from diverse backgrounds often experience poorer access to and outcomes from psychological therapy in primary care mental health services in England. This issue is arguably compounded for clients with limited English proficiency or those who wish to access therapy in other languages. Guidance on interpreter-mediated therapy provides essential recommendations to ensure equitable access, effective communication, culturally sensitive care, and parity in outcomes. Despite these guidelines, they are not always consistently implemented in clinical practice. This study aims to explore and address staff experiences and perspectives on the barriers to interpreter-mediated therapy within Talking Therapies for anxiety and depression (TTad). An online survey was used to collect data on professionals’ experiences and perceptions of these barriers. A total of 133 staff working within TTad completed the survey. The data was analysed using reflexive thematic analysis (RTA), revealing four key themes: (1) individual level, (2) service level, (3) organisational level, and (4) overlapping barriers. The study highlights that while the barriers to effective interpreter-mediated therapy are distinct across individual, service, and organisational levels, they are also interdependent and often overlap. The findings suggest that addressing these barriers requires a comprehensive approach that considers the interconnected nature of these challenges. Improving training for both therapists and interpreters, enhancing administrative processes, ensuring sufficient funding, and promoting adherence to best practice guidelines are crucial. Future research and continued efforts to implement and monitor these changes are essential for improving access and outcomes for clients within TTad. Key learning aims (1) To explore the experiences of TTad staff in interpreter-mediated therapy, examining the practical barriers and interpersonal challenges they face in delivering effective care. (2) To identify and understand the distinct yet inter-related barriers to interpreter-mediated therapy, highlighting how these contribute to the overall challenges in delivering therapy. (3) To recognise the gap between existing guidelines for interpreter-mediated therapy and their implementation in clinical practice, emphasising the need for consistent application and better adherence. (4) To advocate for a strategic and comprehensive approach to addressing barriers that involve shared responsibility across all staff and levels of TTad. (5) To underscore the necessity of continued research and regular monitoring to improve interpreter-mediated therapy, ensuring that clients with limited English proficiency receive equitable access to mental health services in the long term.

Abstract Despite high levels of depression and anxiety, there is relatively little attention to psychological treatment approaches to mental health issues for older adults living in nursing homes. Recent studies support the use of cognitive behaviour therapy (CBT) in this population and here we aim to highlight how CBT can be successfully adapted and implemented with beneficial results. The ELders AT Ease (ELATE) program is a unique service delivery model illustrating delivery of CBT with older adults living in nursing homes. The six modules forming the program, based on CBT, are described. A systems wide approach to delivery is emphasised and illustrated through two clinical case descriptions. Innovative mental health programs can have positive benefits for both residents and staff and support the use of CBT in this vulnerable and under-served client group. Key learning aims (1) Knowledge of the content and application of CBT for older adults living in nursing homes. (2) Understanding of CBT session structure as applied to older adults living in nursing homes. (3) Recognising and utilising specific strategies to highlight a systemic approach as central to implementing CBT strategies, such as behavioural activation and reminiscence, with considered involvement by staff and family.

Abstract The notion of cognitive detachment (i.e. the capacity to treat thoughts as just thoughts, with no greater significance or importance) is introduced in this paper. Its link to similar established terminologies (e.g. distancing, decentering, defusion/deliteralisation, detached mindfulness), importance within cognitive behaviour therapies and place within an adapted cognitive-behavioural framework is highlighted. The use of metaphor to facilitate cognitive detachment is then the primary focus of the paper. An overview of how metaphor has typically been used within psychotherapy is presented and reflects mostly the use of therapist-generated metaphor for psychoeducational purposes. While the use of metaphor in serving a therapeutic cognitive detachment function is not new, developing idiosyncratic client-generated metaphors in this regard has been largely neglected, despite the widely held view that client-generated metaphors are more potent. Practical guidance on how clinicians can collaboratively assist clients to intentionally generate their own personalised cognitive detachment metaphor is provided, and specific ways to elaborate metaphors during therapy to enhance metaphor application and hence effectiveness in enabling cognitive detachment is considered. Finally, clinical examples are provided to illustrate the varied, creative and rich metaphors that can emerge from this process. Key learning aims (1) To introduce the term cognitive detachment and understand this important therapy target within an adapted cognitive-behavioural framework. (2) To appreciate the broader use of metaphors in therapy and frame metaphor as one method for facilitating cognitive detachment. (3) To motivate therapists to pursue idiosyncratic client-generated metaphor. (4) To provide an instructional script to support therapists to help clients develop a personalised cognitive detachment metaphor. (5) To provide specific guidance to therapists regarding methods for metaphor elaboration.